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2.
INSPIRATION | INNOVATION | TRANSFORMATION
The ARN Defined
THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT
The Attending RN (ARN)
• Ensures collaboration
• Is a consistent presence throughout and
following the patient’s hospitalization
• Core competencies allow the ARN to serve as a
clinical coordinator, facilitator and mentor in
order to cultivate a safe, efficient and effective
environment of care

3.
INSPIRATION | INNOVATION | TRANSFORMATION
Theoretical Basis
THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT
Presence through Attunement
• It is what happens when connection is made and
each person experiences the other as present
• It is through attuning that we form relationships
and our experiences becomes aligned
• The capacity to attune to our patients and
families is a prerequisite for therapeutic care
• It’s not a task; it’s an intentional use of self and
the container for the therapeutic practices of
wondering, following and holding
“See me as a Person: Creating Therapeutic Relationships with Patients and Families”, Mary Koloroutis and Michael Trout, 2012

4.
INSPIRATION | INNOVATION | TRANSFORMATION
Theoretical Basis
THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT
Wondering
A practice of discovery grounded in curiosity and
genuine interest in others
Following
The practice of listening, respecting and acting on what
we learn from our patients and families
Holding
Creating a safe haven for healing in which people feel
accepted and held with dignity and respect
“See me as a Person: Creating Therapeutic Relationships with Patients and Families”, Mary Koloroutis
and Michael Trout, 2012

5.
INSPIRATION | INNOVATION | TRANSFORMATION
The ARN Selection Criteria
THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT
A staff nurse who has:
• Strong interpersonal relationship skills
• Emotional intelligence
• Resiliency
• A sense of humor
• Credibility with all members of the team
• A sense of joy

6.
INSPIRATION | INNOVATION | TRANSFORMATION
The ARN Selection Criteria
THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT
A staff nurse who has (continued):
• Clinical expertise
• The ability to be flexible, creative, innovative
• The ability to act calm under pressure
• Passion
• A bit of risk taking behavior
• Commitment to the power of the role

9.
INSPIRATION | INNOVATION | TRANSFORMATION
Actualizing the ARN Role
THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT
• Coordinates meetings with clinicians for timely
decision-making and optimizes handoffs across
the continuum
• Communicates with the patient and family,
discusses plan of the day, etc
• Serves as a role model for interdisciplinary
problem-solving
• Transmits all key information to covering
clinician(s) in an efficient, comprehensive
manner when handoffs are required

10.
INSPIRATION | INNOVATION | TRANSFORMATION
Actualizing the ARN Role
THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT
• Organizes twice daily care team huddles
• Meets with family on a continuous basis
regarding plan of care, disposition, goals of
treatment, palliative care, end of life issues
• Meets weekly with all members of the healthcare
team to design, coordinate and evaluate the plan
of care

11.
INSPIRATION | INNOVATION | TRANSFORMATION
The ARN Scope of Practice
THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT
Massachusetts General Laws, Chapter 112, section 80B defines the legal practice
of nursing in the Commonwealth as,
“Those services which assist individuals or groups to maintain or attain optimal
health. Nursing practice requires substantial specialized knowledge of nursing
theory and related scientific, behavioral and humanistic disciplines…
…Nursing practice involves clinical decision making leading to the development
and implementation of a strategy of care to accomplish defined goals…
…shall include, but not be limited to the performance of services which promote
and support optimal functioning across the life span; the collaboration with
other members of the health team to achieve defined goals; health counseling
and teaching; the provision of comfort measures; teaching and supervising
others; and participation in research which contributes to the expansion of
nursing knowledge.”

13.
INSPIRATION | INNOVATION | TRANSFORMATION
The ARN Scope of Practice
THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT
The ANA Code of Ethics for Nurses at Provision 7 states, “The
nurse participates in the advancement of the profession
through contributions to practice, education, administration
and knowledge development.”
7.1: Advancing the profession through active involvement in nursing and in
healthcare policy.
7.2: Advancing the profession by developing, maintaining, and implementing
professional standards in clinical, administrative, and educational
practice.
7.3: Advancing the profession through knowledge development,
dissemination, and application to practice.

14.
INSPIRATION | INNOVATION | TRANSFORMATION
The ARN Development
THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT
Dreyfus Model of Skill Acquisition
as applied by Benner to Nurses

15.
INSPIRATION | INNOVATION | TRANSFORMATION
The ARN Development
THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT
Stage 1: Novice
• The nurse at this stage has no experience
• Their practice is rule governed
• They must learn the rules to guide their actionsfollowing the rules is good practice
• They cannot yet grasp context-specific meanings
• Their practice is limited and inflexible because they do
not yet have the experience to draw on

16.
INSPIRATION | INNOVATION | TRANSFORMATION
The ARN Development
THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT
Stage 2: Advanced Beginner
• Feels secure with practice directed by orders, rules and
procedures or “common practices.” Feels they can rely on
protocols
• Multiple & competing tasks show up as an overwhelming list of
things that must be done
• They feel responsible for completing the tasks- engagement is
with the tasks
• Good day is defined as getting everything done
• Delegate up
• Focus on the immediate present
• In rapidly changing situations - misses subtle cues of problems

18.
INSPIRATION | INNOVATION | TRANSFORMATION
The ARN Development
THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT
Stage 4: Proficient
• Stage of rapid learning - the patient and their
needs are the focus
• Skill of seeing - narratives reflect overturned
expectations and seeing contextual and
situational changes that require actions other
than those planned or anticipated
• Recognize patterns of signs and symptoms and
their meanings
• Numbers gain meaning or salience

19.
INSPIRATION | INNOVATION | TRANSFORMATION
The ARN Development
THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT
Stage 5: The Expert
• Attention and actions are guided by the patient’s needs
and changing responses, and demands
• Fusion of thought and action
• Clinical forethought
• Fluid, skillful maneuvering in very complex and difficult
situations
• Intuition - direct understanding of the particulars of a
situation without conscious deliberation, awareness or
articulation

20.
INSPIRATION | INNOVATION | TRANSFORMATION
The ARN Future
THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT
The Future of Nursing: Leading Change, Advancing Health
1. Nurses should practice to the full extent of their education and
training.
3. Nurses should be full partners, with physicians and other health
care professionals, in redesigning health care in the United
States.
Conclusion
“The United States has the opportunity to transform its health care
system, and nurses can and should play a fundamental role in
this transformation.”
Ref: IOM, October 2010